Cases reported "Rib Fractures"

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11/22. Nonunion of a first rib fracture in a gymnast.

    Isolated fracture of the first rib is uncommon, but has been reported to occur in sports such as basketball, baseball, and dancing. It has not been reported to occur in gymnasts. Usually, these fractures heal with an adequate period of rest. Rarely do first rib fractures become nonunions. They have been felt to be asymptomatic and are usually found incidentally on routine chest roentgenograms. Symptomatic nonunion of a first rib fracture has not been reported previously. Our patient did not respond to nonoperative treatment and required surgical intervention to alleviate her symptoms. We agree that most fractures of this type heal without complications. However, if a persistently symptomatic nonunion ensues, we suggest transaxillary resection of 90% or more of the first rib.
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ranking = 1
keywords = operative
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12/22. Open fixation of flail chest after blunt trauma.

    Progressive left chest volume loss developed in a patient with severe flail chest despite reasonable oxygenation without intubation. Because of this chest volume loss, pain, and shortness of breath, she underwent open chest wall repair using multiple metallic struts. Rapid recovery ensued, despite a perforated duodenal ulcer on postoperative day 1. Benefits of open fixation of severe flail chest are clearly demonstrated and should be considered instead of prolonged ventilation or supportive care alone for select patients.
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ranking = 1
keywords = operative
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13/22. Fatal intraoperative hemorrhage during spinal fusion surgery for osteogenesis imperfecta.

    osteogenesis imperfecta (OI) is an uncommon inherited systemic disorder of the connective tissues characterized primarily by varying degrees of bony fragility. Consequently, individuals affected by this condition frequently suffer severe skeletal injuries from otherwise innocuous traumatic events. This syndrome has other associated abnormalities, including hydrocephalus and brain stem compression on the basis of cranial developmental defects (platybasia), cardiac and vascular problems, respiratory disease from spinal deformities, vascular fragility, a bleeding disorder caused by an apparent platelet function abnormality, and anesthesia-related hyperpyrexia. A case is presented here of a young girl with advanced OI in whom intraoperative death occurred as a consequence of inadvertent rib fractures, with subsequent uncontrollable hemorrhage. OI may also potentially be mistaken for child abuse by an inexperienced examiner.
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ranking = 5
keywords = operative
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14/22. rupture of the cervical esophagus from blunt trauma.

    A patient had a left anterolateral linear tear of the lower cervical esophagus with concomitant second rib fracture after a steering wheel injury. diagnosis of the lesion was delayed because of initial absence of physical signs. Subsequent operative drainage and repair were unsuccessful.
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ranking = 1
keywords = operative
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15/22. pseudomonas infection of the sternum and costal cartilages. Report of three cases.

    pseudomonas osteochondritis of the chest wall and sternum has rarely been reported, but when present it has been extremely difficult to eradicate. Multiple operations to debride the involved areas and use of antibiotics have often been inadequate to control this resistant infection. This report describes our experience with three patients who had the late development of pseudomonas osteochondritis of the chest wall. The infection occurred following crush trauma, sternotomy for congenital heart disease, and mastectomy and amputation of the upper extremity for carcinoma of the breast. Antibiotic therapy alone and with limited operations was unsuccessful in controlling the infection in all three instances. Eventually, each patient required extensive regional surgical removal of involved bone and cartilage. Complete healing followed. Our experience favors the early wide removal of bony and cartilaginous tissues in the involved region with preoperative and postoperative coverage by appropriate antibiotics. Operative management is detailed.
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ranking = 2
keywords = operative
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16/22. Subarachnoid-pleural fistula in traumatic paraplegia.

    Subarachnoid-pleural fistulas caused persistent pleural effusion in 2 patients with traumatic paraplegia. The fistulas were diagnosed by myelography and radioisotope scan. Most of the previously reported cases of this rare entity have been treated by operative closure of the fistula. Both of the reported patients recovered: one underwent insertion of chest tubes to promote drainage and the other had no specific therapy. The authors believe conservative treatment should be attempted before surgery is considered.
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ranking = 1
keywords = operative
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17/22. Intrathoracic displacement of the humeral head with fracture of the surgical neck.

    Intrathoracic displacement of the humeral head occurred in a man in association with fracture of the surgical neck of the humerus. This report describes the mechanism of the injury and a method of operative exposure.
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ranking = 1
keywords = operative
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18/22. Strangulation: a late presentation of right-sided diaphragmatic rupture.

    A case of late presentation of a right-sided diaphragmatic rupture due to blunt chest trauma is presented. The patient suffered from strangulation of a herniated segment of small bowel into the chest. Chest radiography suggested diaphragmatic rupture, computed tomography and sonography established the correct preoperative diagnosis. The prevalence, mechanism of injury and possible complications are reviewed. The value of chest radiography and other imaging techniques is discussed.
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ranking = 1
keywords = operative
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19/22. Chest x-rays before ophthalmic surgery.

    We retrospectively reviewed clinical records and preoperative chest x-ray films of 636 patients who had been admitted for ophthalmic surgery in 1990 and 1991. In our hospital, a preoperative chest roentgenogram routinely was examined for each patient. A total of 228 patients (35.8%) had an abnormal preoperative result. These abnormalities were more frequent in patients older than 40 years of age than in younger patients. pulmonary fibrosis and calcification were the most common abnormal findings. Also, we noted that 202 patients (31.8%) had a chronic, previously known, or suspected, finding, and 26 patients (4.1%) had a new or unsuspected finding. The surgery was postponed or canceled in five patients (0.8%) because of the abnormal x-ray results.
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ranking = 3
keywords = operative
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20/22. Traumatic rupture of the ascending aorta and aortic valve following blunt chest trauma.

    Traumatic rupture of the aorta at the level of the isthmus is a well-recognized injury following blunt chest trauma. By contrast, rupture of the ascending aorta and of the aortic valve in a road traffic accident is rare and does not appear to have been previously reported. The occurrence of such an injury in a 56-year-old man involved in a road traffic accident is reported. The diagnosis was made preoperatively following aortography and successful surgical correction involved aortic valve replacement with resection and grafting of the damaged area of the ascending aorta. The probable mechanisms involved in the production of this unusual injury are discussed.
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ranking = 1
keywords = operative
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